Arthur H. Aufses, Jr. MD Archives Blog

Chats for Change – Mount Sinai History Series

Aug 27, 2024

This year we’re discussing aspects of Mount Sinai’s history as a community by joining forces with the Institute for Equity and Justice in Health Sciences Education  through a series of three Chats for Change programs. In this post I’ll provide some background about what Chats for Change is, how it came to be, the Institute team we’re working with this year, and what the Archives brought to table. 

About Chats for Change

In 2015, Mount Sinai launched the Racism and Bias Initiative (RBI) to center underrepresented voices and experiences, recognize the historical underpinnings of racism and bias in medicine, and explicitly address and undo racism and bias in all functional areas of the medical school. Beginning in the fall of 2018, the Department of Medical Education launched “Chats for Change”—a series of dialogues centered on racism and bias in medicine. 

Chats for Change was developed in response to medical education staff, faculty, and medical students who wanted dedicated time to engage in a dialogue as a community and deepen their understanding of and ability to address racism. These sessions were based on the notion that in order to respond to racism and to be anti-racist, we must engage in dialogue, learning, and action. Participants include staff, faculty, and students from across the School and Health System. There is also a National Chats for Change available to all medical schools in North America.  

The Process

How does this work? The structure of Chats for Change remains the same regardless of the topic. Held over Zoom, facilitators provide some introductory background information and review the grounding assumptions for the dialogue about to take place. The grounding assumptions that I find change the power dynamics are  “everyone here is all we need” and “refrain from expecting experts or others to know best.” In both education and healthcare, there is deeply ingrained respect for and deference to expertise.  Asking participants to shift out of this mindset is a challenge and requires intentional interactions outside the traditional norms and hierarchy.

The facilitators review the process and hen there is a brief check-in to get everyone acquainted. The next portion is framing and defining that day’s topic with a brief presentation, about ten minutes long.

We then review norms for the breakout groups in which the participants are about to participate:   

  • All of us are taught misinformation about our own group(s) and about members of other groups 
  • We agree not to blame ourselves or others for the misinformation we have been taught, and to accept responsibility for not repeating misinformation after we have learned otherwise 

The participants enter the breakout rooms with some questions to guide their discussion, keeping in mind that there will be a debrief with the whole group afterwards to share any themes, insights, similarities and/or differences (as shown on the slide here). Every session ends by asking “given today’s dialogue, what do you need to learn and unlearn?”, followed by a request for  feedback and a preview of the next week’s topic.

2024 Spring/Summer Season

In planning the 2024 Chats for Change season, Leona Hess, PhD, MSW, Co-Director of the Institute, invited me (the Aufses Archives’ director) to join in on brainstorming topics for discussion. 

For this year, we arrived at the following groupings: 

  • Series on Understanding Islamophobia and Antisemitism  

Given the horrific increase in hate crimes against Muslim and Jewish people, it’s imperative for us to commit to deeper understanding and reflection.  

  • Antiracism Fellow Series  

This year’s Institute for Equity and Justice in Health Sciences Education Antiracism Fellows will introduce new topics, challenging all of us to critically examine pressing contemporary issues and the role of medical students.  

  • Mount Sinai History Series  

Pulling from resources in the Aufses Archives, we will uncover how Mount Sinai’s past shows up in our present, how equitable treatment regardless of the ability to pay is a relatively new concept, and how our patient populations have been recorded and reported at different moments in our hospitals’ histories. 

  • Rejuvenate and Restore (R&R) Series  

With everything going on, we can still find time for joy, future dreaming, and collective care. 

In addition to these series, there were one-off chats on decolonizing global health, cybersafety, the rural vs. urban divide, and much more.  

Mount Sinai History Series

The first Mount Sinai History Series took place on April 23rd, exploring the question, How Does Our Past Show Up in Our Present? by reflecting on our hospitals’ and medical school’s founding charters, articles of incorporation, and mission statements.

At Mount Sinai we often cite our origin story, the opening of Jews’ Hospital in New York in 1855, as a core element of our identity: to treat those who were refused treatment elsewhere (at the time, people of Jewish faith, and accident victims). As a health system, we are now multiple hospitals and a medical school. Pulled from resources in the Aufses Archives, we considered how the histories of these institutions shape us today. To do this, I started with a quote from the Charter of the Jews’ Hospital (which became Mount Sinai Hospital in 1866).

New York State Charter of the Jews’ Hospital in New York

January 16, 1852

We have associated and hereby do associate ourselves into a benevolent, charitable and scientific Society… to be known… by the name of The Jews’ Hospital in New York… the particular business, purpose and object of such… will be the medical and surgical aid to persons of the Jewish persuasion.

Quote from the 1852 Charter

First Mission Statement of The Mount Sinai Medical Center

1979

The focus was on the mission statements and articles of incorporation that state the reasons why the hospitals were created and what they were intending to do. I have found that these statements do resonate with our values and mission today, so I wanted to see how others felt. We asked the Chats participants, “what parts of our legacies most resonate with you?” There was a good discussion.

The second session, Unified Care?, was about how patients have historically been segregated by ability to pay and other factors. This was co-hosted by Dr. David Muller, Director of the Institute for Equity and Justice in Health Sciences Education. We are working towards health equity, we want everyone to have the same care, but there has always been a way of dividing patients that persists today. Goal was to show past practices–the general open ward layout, transition to semi-private rooms, and entirely private care–that demonstrate how we evolved into the patient placements we see in today’s hospitals.

1904 Hospital Layout
1906 Female Ward
1904 Private Patient Room

The final session, Who Sought Treatment, took place in August and covered how hospitals have tracked and reported demographics of the patients who sought treatment. Today we are familiar with tracking patient outcomes by identities, such as race or gender–but this has not always been the case. As New York’s demographics have changed through time, so too have the data recorded about people seeking medical care. We looked at hospital reporting to see how patient populations have been recorded and reported at different moments in our hospitals’ histories. We reflected on how our practices have evolved.

As Mount Sinai Hospital was established to care for immigrants, nativity was most frequently reported. The sex, occupation, age, and other categories were also typically tabulated.

Report on patients from Mount Sinai Hospital’s 1866 Annual Report, page 24

Listed: Number of admitted and refused in a single month (over the course of the year) and age.

Report on patients from the 1866 Annual Report, page 25

Listed: civil Condition, term of Residence in the U.S., nativity, and occupation.

Beth Israel Hospital Annual Report from 1903 stated, “the nativities of the patients reveal at once the broad spirit prevailing in the management of the Hospital. Beth Israel knows no difference in creed, class or color, when suffering humanity appeals to it for aid and relief?”

St. Luke’s Hospital Annual report, 1910

Listed nationality and religious denominations, and occupations of patients.

Mount Sinai is based in East Harlem, over half of the population are of Puerto Rican and Dominican ancestry. This document shows when the hospital first became cognizant of the growing population and demographic shifts in the late 1920s. The language is not current, and we say Latino instead of “‘Spanish’ nativity.”

I am so grateful to Leona, David, and the team (Jay especially), who were incredibly supportive partners. They have a the structure of Chats for Change in place, facilitate adeptly, handle the logistics seamlessly—piloting the Mount Sinai History series could not have happened without their partnership.

Authored by J.E. Molly Seegers

The Influence of the 1863 Draft Riots on Jews’ Hospital in New York’s Sectarian Policy

Mar 2, 2022

Title page of the Annual Report of the Directors of Jews' Hospital in New York

Title page of the 1864 Annual Report of the Directors of Jews’ Hospital in New York

Mount Sinai Hospital’s predecessor institution, Jews’ Hospital in New York, was established in 1852, opened in 1855, and initially admitted only people of the Jewish faith and accident victims. A mere twelve years later in 1864 the Board of Directors decided to open the hospital to all, regardless of faith. Then in 1866, to reflect this new policy, the institution changed its name to Mount Sinai Hospital. But why did the Hospital become non-sectarian? At a point in time when many Hospitals founded by other creeds continued their religious affiliations, Jews’ Hospital broke with tradition. It might come as a surprise that the decision to treat people regardless of faith was influenced by the Civil War and the New York City Draft Riots of 1863, one of the “bloodiest race riots in American history.” The profound devastation wrought upon Black people during the gruesome riots shaped New York as we know it today and had a profound impact on the early days of our health system.

In the introduction to The First Hundred Years of The Mount Sinai Hospital of New York, 1852-1952, the authors posit that Jews’ Hospital, as it was in the geographic center of the riots, was “the asylum for their dead and injured. An eventual result for the Hospital was its adoption of the nonsectarianism which has been its policy ever since.” Which begs the question: who did they treat, and did treating victims of the riots actually persuade the Hospital’s Leadership to change its policy? To answer that question, we need to know what occurred in New York City during the years leading up to the 1864 decision. The United States was in the thick of the Civil War which raged from 1861 to 1865. New York City, while positioned as a northern city allied with the Union, was in fact quite a conservative city due to its financial connections to the south.

Section of map from 1869 showing the Jews' Hospital

Section 1869 map of New York showing the Jews’ Hospital in blue rectangle (map courtesy of Lionel Pincus and Princess Firyal Map Division, The New York Public Library)

During the Civil War the Jews’ Hospital in New York was located on the south side of 28th Street between 6th and 7th Avenues and admitted on average 30 patients a month. In 1864 the staff consisted of three consulting surgeons, three attending surgeons, four attending physicians, “one resident physician and house surgeon, one superintendent, three nurses, three domestics, and one cook.” Annual reports state that from 1855 to 1860 the Hospital treated 1,285 people. However, during the war years, we are unable to say how many in total were admitted because we do not have annual reports for the years 1861, 1862, and 1863. However, Dr. Teller, House Physician and Surgeon, gave monthly reports on all but a few occasions to The Occident and American Jewish Advocate:

Dr. Teller either did not report the 1863 June and July statistics or the newspaper did not include them. But August, the month after the draft riots, the number of patients treated, 113, is higher than usual.

The Hospital underwent a great transformation during the Civil War. One of its three Attending Surgeons, Dr. Israel Moses, left to serve in the Union Army. Joseph Seligman, who had been on the Hospital’s Board since 1855 resigned his position in 1862 because of his “increasing responsibilities” frequently attending advisory meetings with President Lincoln. The most dramatic change was in 1861 when the Board of Directors resolved to establish a ward for injured Union soldiers, first totaling 48, then 69 beds.

The federal draft law was put into place in the summer of 1863, but it provided an exemption for people who could pay $300 or find someone to take their place. This infuriated the working class, the Irish and other recent immigrants, especially in New York, where Union loyalty was not a given. After the names had been drawn for the first round and published in the weekend’s papers, many New Yorkers were enraged. A large mob formed on the next day, and proceeded to attack and burn down the Provost Marshal’s building, where the draft was taking place. From there the mob moved all around the city, rioting, burning down entire buildings, injuring innocent bystanders, looting and committing outright murder. Described as “bitter street-to-street warfare”, the city was in chaos for four days. 

Black people were the primary target of the mob’s atrocious violence due to racism and scapegoating, newspapers having created the narrative that enslaved people, once free, would take jobs from recent immigrants. Mobs lynched eleven Black men, hanging their mutilated bodies from lampposts. The total death count is unknown, but estimates range from over 100 to several hundred. The repercussions of the four days of extreme violence shape New York City even today. Because of the riots, it is estimated that nearly a thousand Black New Yorkers fled Manhattan en masse, seeking permanent refuge elsewhere, leaving behind their homes and communities. In their exodus from what was a racially integrated city, they settled in safer places, such as the historic Black community of Weeksville in Brooklyn (which was a city in its own right at the time). In the aftermath, New York became a more segregated city.

A report of the City Inspector detailing the casualties of the prior week

Excerpt from the July 21, 1863 edition of The New York Herald showing 106 deaths from violent causes, presumably the Draft Riots.

One early Mount Sinai doctor recalled:

In the early [1860’s] the hospital must have had its share of the casualties from the draft riots which occurred in the neighborhood, and of which I was in part an eyewitness: the burning of the colored Orphan Asylum in 40th Street, the attack on the Provost Marshall’s office on Broadway and 28th Street, the hanging of a [Black man] to a lamp post at 6th Avenue and 33rd Street, and the escape of frightened colored men, women, and children from the mob to the State Arsenal at 35th Street and Seventh Avenue under protection of a squad of soldiers.

Do we know how many people were treated at the Jews’ Hospital? While the Archives does not possess the case books from that era, we know that, “the geography of the rioting was such that Jews’ Hospital was frequently the center of its fury, and during the bloody days that ensued, it became the sanctuary of the sick and the wounded.” The newspapers of the time described multiple extremely violent events that took place only a few blocks from the Hospital. In all likelihood, the Hospital treated dozens of riot victims and the staff would witness the particular terror and brutal violence inflicted upon Black people.

In reading the minutes’ book entries of the subsequent months, there seems to be no end to the mundane issues the Board of Directors addressed. Rarely is there an explanation of motive or greater historical context included with a decision recorded in such matter of fact reports. However, in the months following the riots, the Hospital’s Board of Directors were:

Sensitive to their obligations to the country and the community during this period, the Board of Directors was also preparing the ground for the nonsectarian policy which has distinguished the Hospital ever since. Accident patients of all nationalities, races and religions had been accepted since the first day of the Hospital’s existence. But the national crisis crystallized the Board’s determination to rise above sectarianism and abolish it completely. In 1864, the Executive Committee had reported, “The Committee deem it proper to observe that many of those admitted to the Hospital were not of our faith, no distinction ever being made as to either the nationality or the religious belief of the sufferer.”

 

References

Albon P. Man. “Labor Competition and the New York Draft Riots of 1863.” The Journal of Negro History, vol. 36, no. 4, 1951, pp. 375–405. https://doi.org/10.2307/2715371.

Hirsch, Joseph and Doherty, Beka. The First Hundred Years of the Mount Sinai Hospital of New York, 1852-1952. Random House: New York, 1952.

Jews’ Hospital in New York. Annual Report of the Directors of the Jews’ Hospital in New York, 1860. https://archive.org/details/annualreportofdi1860jews/page/18/mode/2up

Meyer, Alfred. “Recollections of Old Mount Sinai Days.” Journal of the Mount Sinai Hospital, vol. 3, no. 6, 1937, pp. 295-307.

 

Authored by J.E. Molly Seegers